This is a multi-centered, prospective, randomized, unblinded, controlled trial to examine the effect of primary peritoneal drainage compared to laparotomy and bowel resection for the treatment of perforated necrotizing enterocolitis in very low birth weight infants. The study will test the hypothesis that primary peritoneal drainage improves survival over laparotomy and bowel resection in premature infants with perforated necrotizing enterocolitis.